Download Facial danger zones

FACIAL DANGER ZONES
DR.MAHMOUD GH. FAKIHA,DESC
Assistant professor of plastic surgery
Facial danger zone 1
Anatomy
•
Facial danger zone 1 is
centered around a point in the
middle of the
sternocleidomastoid muscle
belly 6.5 cm below the caudal
edge of the external auditory
canal .
•
It contains the emergance of
THE GREAT AURICULAR
NERVE from beneath the
sternocleidomastoid muscle ,
becomes more superficial ,
and is thus more susceptible
to injury .
Consequence of injury
•
Permanent injury to the nerve results in numbness of or, painful
dysesthesia of the lower two thirds of the ear & adjacent neck and cheek
skin .
Surgical dissection
•
After the postauricular incision is
made ,it is helpful to begin the
dissection superficially , just deep
to the subcutaneous fat , which is
thin and superficial to the deep
cervical fascia and the
sternocleidomastoid muscle .
• The nerve is posterior to and
not protected by the
platysma through most of its
course .
• Note :
 Terminal branches
 External jugular vein
Facial danger zone 2
Anatomy
•
It is outlined by drawing a line
0.5 cm below the tragus to a
piont 2 cn above the lateral
eyebrow , drawing a second
line on the zygoma to the
lateral orbital rim ,and
connecting these two lines with
athird line .
•
In this zone the TEMPORAL
BRANCH OF THE FACIAL
NERVE lies on the
undersurface of the temproparital facia .
Consequence of injury
•
•
Injury to the temporal branch results in paralysis of the frontalis muscle .
Clinically ,the involved side of the forehead becomes parylized , with
resultant ptosis of the brow , asymmetry of the eyebrows .
Surgical dissection
Facial danger zone 3
Anatomy
•
It is defined by a piont drawn on the midmandible at a level 2 cm posterior
to the oral commissure and a circle drawn with a radius of 2 cm around this
point .note the proximity to ant. Facila a. & v. .
Consequence of injury
•
This nerve innervate the depressor anguli oris muscle .injury creates a
noticeable and extremely distressing deformity .
Surgical dissection
•
Be careful during subcutaneous dissection and using electrocautary
Facial danger zone 4
Anatomy
•
It is deep to the parotid fascia
. It is outlined by placing a
mark on the highest point of
malar eminence , another one
on the mandibular angle , and
a third mark at the oral
commissure .
•
This triangle contains thr
ZYGOMATIC and BUCCAL
branches of facial n.
Consequence of injury
•
Injury to these nerves can result in paralysis of the zygomaticus major &
minor m. and levator labii superioris alaeque nasi m. ,causing the upper lip
and oral commissure on the affected side to sag .
Surgical dissection
Facial danger zone 5
Anatomy
•
It is defined by a circle with a RADIUS OF 1.5 CM DRAWN AROUND THE
SUPRAORBITAL FORAMEN.
Consequence of injury
•
Injury to SUPRAORBITAL & SUPRATROCHLEAR branches results in
numbness or painful dysesthesia of the medial forehead ,scalp , upper
eyelid , and nasal dorsum
Surgical dissection
Facial danger zone 6
Anatomy
•
It is described by a circle with
a 1.5 cm radius around the
infraorbital rim , along the
line down through the
midpupil and second
mandibular premolar.
Consequence of injury
•
Injury to INFRAORBITAL N. lead to numbness of the lateral nose ,cheek,
upper lip , and inferior eyelid
Surgical dissection
•
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During :
Subcutaneous dissection
Extended subperiosteal face lift
rhinoplasty